IRB LÉRIDA - Instituto de Investigación Biomédica de Lérida (Cataluña)

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12105/16986

El Instituto de Investigación Biomédica de Lleida (IRBLleida) se fundó en 2004 mediante un convenio de colaboración entre la Universidad de Lleida (UdL) y el sistema sanitario catalán. El IRBLleida es un instituto que se organiza según un modelo de buen gobierno y funcionamiento que garantiza la eficiencia, la flexibilidad de la gestión, la captación y promoción del talento, la planificación estratégica y la capacidad ejecutiva. Acreditado por el Instituto de Salud Carlos III como Instituto de Investigación Sanitaria en 2014, y renovando esta acreditación cada 5 años, forma parte así del total de 34 Institutos de Investigación Sanitaria acreditados existentes en la actualidad.

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Healthcare and Epidemiological Surveillance Costs of Hepatitis A Outbreaks in Spain in Regions with and without Universal Hepatitis A Vaccination of Children during 2010-2018
(Multidisciplinary Digital Publishing Institute (MDPI), 2024-06-11) Plans-Rubió, Pedro; Pericas, Carles; Avellón, Ana; Izquierdo, Concepción; Martínez, Ana; Torner, Núria; Martínez, Alejandro; Borràs, Eva; Roig, Francisco; Godoy, Pere; Rius, Cristina; Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública); Instituto de Salud Carlos III
The aim of this study was to evaluate and compare hepatitis A outbreak-associated healthcare and epidemiological surveillance costs in Spain in two types of autonomous regions during 2010-2018: (1) regions with a prevention strategy based on universal hepatitis A vaccination of children and vaccination of high-risk population groups (Catalonia) and (2) regions with a prevention strategy based on vaccinating high-risk population groups (Castile and Leon, Murcia, Navarra, Community of Madrid, Community of Valencia). Healthcare costs were determined based on the resources used to treat hepatitis A outbreak-associated cases and hospitalizations. Epidemiological surveillance costs were calculated from the resources used during surveillance activities. The ratios for total, healthcare and epidemiological surveillance costs (regions without universal hepatitis A vaccination of children vs. Catalonia) were used to compare the two hepatitis A prevention strategies. From 2010 to 2018, the total, healthcare and epidemiological surveillance costs per million population were 1.75 times (EUR 101,671 vs. EUR 58,032), 1.96 times (EUR 75,500 vs. EUR 38,516) and 1.34 times greater (EUR 26,171 vs. EUR 19,515) in regions without universal hepatitis A vaccination of children than in Catalonia, respectively. The ratios tended to increase over time during 2010-2018. In 2015-2018, total, healthcare and epidemiological surveillance costs per million population were 2.68 times (EUR 69,993 vs. EUR 26,158), 2.86 times (EUR 53,807 vs. EUR 18,825) and 2.21 times greater (EUR 16,186 vs. EUR 7333) in regions without universal hepatitis A vaccination of children than in Catalonia, respectively. These findings suggest that universal hepatitis A vaccination of children could reduce hepatitis A outbreak-associated costs.
Impact of the Universal Implementation of Adolescent Hepatitis B Vaccination in Spain
(Multidisciplinary Digital Publishing Institute (MDPI), 2024-05-01) Domínguez, Angela; Avellón, Ana; Hernando Sebastian, Victoria; Soldevila, Núria; Borràs, Eva; Martínez, Ana; Izquierdo, Conchita; Torner, Núria; Pericas, Carles; Rius, Cristina; Godoy, Pere; Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública); Instituto de Salud Carlos III
The aim of this study was to analyse the impact of the introduction of universal adolescent HBV vaccination on the incidence of acute hepatitis B virus (HBV) infections. Acute HBV cases reported to the Spanish National Epidemiological Surveillance Network between 2005 and 2021 were included. For regions starting adolescent vaccination in 1991-1993 and in 1994-1996, HBV incidence rates were compared by calculating the incidence rate ratio (IRR) and 95% confidence interval (CI). We also analysed the 2017 Spanish national seroprevalence survey data. The overall acute HBV incidence per 100,000 persons was 1.54 in 2005 and 0.64 in 2021 ( < 0.001). The incidence in 2014-2021 was lower for regions that started adolescent vaccination in 1991-1993 rather than in 1994-1996 (IRR 0.76; 95% CI 0.72-0.83; < 0.001). In the 20-29 age group, incidence in regions that started adolescent vaccination in 1991-1993 was also lower (IRR 0.87; 95% CI 0.77-0.98; = 0.02 in 2005-2013 and IRR 0.71; 95% CI 0.56-0·90; < 0.001 in 2014-2021). Anti-HBc prevalence in the 35-39 age group was lower in the regions that started vaccination earlier, although the difference was not statistically significant ( = 0.09). Acute HBV incidence decreased more in the young adult population in regions that began adolescent vaccination earlier. Maintaining high universal vaccination coverage in the first year of life and in at-risk groups is necessary to achieve HBV elimination by 2030.
A genome-wide association meta-analysis of all-cause and vascular dementia
(Wiley, 2024-09) Mega Vascular Cognitive Impairment and Dementia (MEGAVCID) consortium; Calero, Miguel; NIH - National Heart, Lung, and Blood Institute (NHLBI) (Estados Unidos); NIH - National Institute on Aging (NIA) (Estados Unidos); NIH - National Institute of Neurological Disorders and Stroke (NINDS) (Estados Unidos)
Introduction: Dementia is a multifactorial disease with Alzheimer's disease (AD) and vascular dementia (VaD) pathologies making the largest contributions. Yet, most genome-wide association studies (GWAS) focus on AD. Methods: We conducted a GWAS of all-cause dementia (ACD) and examined the genetic overlap with VaD. Our dataset includes 800,597 individuals, with 46,902 and 8702 cases of ACD and VaD, respectively. Known AD loci for ACD and VaD were replicated. Bioinformatic analyses prioritized genes that are likely functionally relevant and shared with closely related traits and risk factors. Results: For ACD, novel loci identified were associated with energy transport (SEMA4D), neuronal excitability (ANO3), amyloid deposition in the brain (RBFOX1), and magnetic resonance imaging markers of small vessel disease (SVD; HBEGF). Novel VaD loci were associated with hypertension, diabetes, and neuron maintenance (SPRY2, FOXA2, AJAP1, and PSMA3). Discussion: Our study identified genetic risks underlying ACD, demonstrating overlap with neurodegenerative processes, vascular risk factors, and cerebral SVD. Highlights: We conducted the largest genome-wide association study of all-cause dementia (ACD) and vascular dementia (VaD). Known genetic variants associated with AD were replicated for ACD and VaD. Functional analyses identified novel loci for ACD and VaD. Genetic risks of ACD overlapped with neurodegeneration, vascular risk factors, and cerebral small vessel disease.
The efficacy of nursing interventions on sleep quality in hospitalized patients: A systematic review of randomized controlled trials
(Elsevier, 2021-03) Bellon, Filip; Mora-Noya, Veronica; Pastells-Peiró, Roland; Abad-Corpa, Eva; Gea-Sánchez, Montserrat; Moreno-Casbas, Teresa
Objective: To determine the effect of interventions that could be performed by nurses to improve the sleep quality of hospitalized patients in acute and semi-acute units. Design: A systematic review of randomized controlled trials and narrative synthesis. Data sources: Seven electronic databases (PubMed, CINAHL Plus, Scopus, ISI WoS, CENTRAL, PsycInfo, and Embase) were accessed on 20 May 2019 with a temporal limit of 10 years prior. Review methods: Original research studies of interventions that could be delivered by nurses to improve sleep quality during hospitalization in acute and semi-acute units were included. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Results: Seventeen studies met the inclusion criteria and were included in this review. The interventions carried out in the trials were classified into four categories of measurement: environmental, physical, behavioural, and combined. Fourteen studies obtained statistically significant improvements; two showed a blend of significant and non-significant improvements; and one reported non-significant results. However, only four trials of the seventeen were judged as having a low risk of bias. Conclusions: Overall evidence about interventions that could be performed by nurses to improve perceived sleep quality in hospitalized patients was found to be positive, and no negative effects were reported. However, higher quality research using both subjective and objective measures is needed, in order to strengthen the evidence.
Hepatitis B Virus-Related Cirrhosis and Hepatocellular Carcinoma Hospital Discharge Rates from 2005 to 2021 in Spain: Impact of Universal Vaccination
(Multidisciplinary Digital Publishing Institute (MDPI), 2024-11-04) Domínguez, Angela; Avellón, Ana; Hernando Sebastian, Victoria; Soldevila, Núria; Borràs, Eva; Martínez, Ana; Izquierdo, Conchita; Torner, Núria; Pericas, Carles; Rius, Cristina; Godoy, Pere; Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública); Instituto de Salud Carlos III
Background: The main consequences of chronic hepatitis B virus (HBV) infections are cirrhosis and hepatocellular carcinoma (HCC), both associated with frequent hospitalization. The aim of this study was to analyze the impact of universal HBV vaccination in Spain on chronic HBV-related hospital discharges from 2005 to 2021. Methods: Using data from the Minimum Basic Data Set of the Spanish National Health System, we calculated the hospital discharge rate ratio (HDRR) and 95% confidence interval (CI) values for chronic HBV-related discharges between 2005 and 2021. For comparative purposes, we calculated the HDRR and 95% confidence interval (CI) values for the early (2005-2013) and later (2014-2021) periods and the vaccinated compared with unvaccinated cohorts for the 20-39 age group. Results: The hospital discharge rate per 1,000,000 people was 3.08 in 2005 and 4.50 in 2021 for HCC, and 4.81 in 2005 and 1.92 in 2021 for cirrhosis. Comparing the early and later periods, values were higher for HCC (HDRR 1.13; 95% CI: 1.06-1.20) and lower for cirrhosis (HDRR 0.56; 95% CI: 0.51-0.60). The rate for the 20-39 age group was lower for the vaccinated compared with the unvaccinated cohorts overall (HDRR 0.53; 95% CI: 0.45-0.62), for HCC (HDRR 0.66; 95% CI: 0.53-0.82), and for cirrhosis (HDRR 0.41; 95% CI: 0.33-0.53). Conclusions: This study describes the important impact, after 25 years, of universal HBV vaccination in Spain: cirrhosis hospital discharge rate was reduced, and the vaccinated cohorts, compared with the unvaccinated cohorts in the 20-39 age group, had a lower hospital discharge rate of both HCC and cirrhosis.
Low anti-SARS-CoV-2 S antibody levels predict increased mortality and dissemination of viral components in the blood of critical COVID-19 patients
(Wiley, 2022-02) Martin-Vicente, Maria; Almansa, Raquel; Martinez, Isidoro; Tedim, Ana P; Bustamante, Elena; Tamayo, Luis; Aldecoa, César; Gómez, José Manuel; Renedo, Gloria; Berezo, Jose Ángel; Cedeño, Jamil Antonio; Mamolar, Nuria; García Olivares, Pablo; Herrán-Monge, Rubén; Cicuendez, Ramón; Enríquez, Pedro; Ortega, Alicia; Jorge, Noelia; Doncel, Cristina; de la Fuente, Amanda; Bustamante-Munguira, Juan; Muñoz-Gómez, María José; González-Rivera, Milagros; Puertas, Carolina; Mas-Lloret, Vicente; Vazquez-Alcaraz, Monica; Perez-Garcia, Felipe; Rico-Feijoo, Jesús; Martín, Silvia; Motos, Anna; Fernandez-Barat, Laia; Eiros, José María; Domínguez-Gil, Marta; Ferrer, Ricard; Barbé, Ferrán; Trapiello, Wysali; Kelvin, David J; Bermejo-Martin, Jesús F; Resino, Salvador; Torres, Antoni; Canadian Institutes of Health Research; Nova Scotia Health Research Foundation; Atlantic Genome (Canada); Li Ka Shing Foundation; Dalhousie Medical Research Foundation; Canada Research Chairs; Instituto de Salud Carlos III; Centro de Investigación Biomédica en Red - CIBERES (Enfermedades Respiratorias); Junta de Castilla y León (España); Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF)
Background: Anti-SARS-CoV-2 S antibodies prevent viral replication. Critically ill COVID-19 patients show viral material in plasma, associated with a dysregulated host response. If these antibodies influence survival and viral dissemination in ICU-COVID patients is unknown. Patients/methods: We studied the impact of anti-SARS-CoV-2 S antibodies levels on survival, viral RNA-load in plasma, and N-antigenaemia in 92 COVID-19 patients over ICU admission. Results: Frequency of N-antigenaemia was >2.5-fold higher in absence of antibodies. Antibodies correlated inversely with viral RNA-load in plasma, representing a protective factor against mortality (adjusted HR [CI 95%], p): (S IgM [AUC ≥ 60]: 0.44 [0.22; 0.88], 0.020); (S IgG [AUC ≥ 237]: 0.31 [0.16; 0.61], <0.001). Viral RNA-load in plasma and N-antigenaemia predicted increased mortality: (N1-viral load [≥2.156 copies/ml]: 2.25 [1.16; 4.36], 0.016); (N-antigenaemia: 2.45 [1.27; 4.69], 0.007). Conclusions: Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. Our findings support that these antibodies contribute to prevent systemic dissemination of SARS-CoV-2.
Clinical performance evaluation of the Idylla™ EGFR Mutation Test on formalin-fixed paraffin-embedded tissue of non-small cell lung cancer
(2020-04-03) Delgado-García, Mercedes; Weynand, Birgit; Gómez-Izquierdo, Lourdes; Hernández, María José; Blanco, Ángela María; Varela, Mar; Matias-Guiu, Xavier; Nadal, Ernest; Márquez-Lobo, Bélgica; Alarcão, Ana; de Álava, Enrique; Biscuola, Michele
Background: Detection of epidermal growth factor receptor (EGFR) mutations in exons 18-21 is recommended in all patients with advanced Non-small-cell lung carcinoma due to the demonstrated efficiency of the standard therapy with tyrosine kinase inhibitors in EGFR-mutated patients. Therefore, choosing a suitable technique to test EGFR mutational status is crucial to warrant a valid result in a short turnaround time using the lowest possible amount of tissue material. The Idylla™ EGFR Mutation Test is a simple, fast and reliable method designed for the detection of EGFR mutations from formalin-fixed paraffin-embedded samples. The aim of this study was the Clinical Performace Evaluation of the Idylla™ EGFR Mutation Test on the Idylla™ System. Methods: EGFR mutational status was determined on 132 archived formalin-fixed paraffin-embedded tissue sections with Idylla™ technology. Results were compared with the results previously obtained by routine method in the reference lab (Therascreen® EGFR RGQ PCR v2, Qiagen in Molecular Pathology lab, Hospital Universitario Virgen del Rocío de Sevilla). Results: The overall agreement between results obtained with the Idylla™ EGFR Mutation Test and the Comparator test method was 95.38% (with 1-sided 95% lower limit of 91.7%) showing Positive Diagnostic Agreement of 93.22% and Negative Diagnostic Agreement of 97.18%, with a Limit Of Detection ≤5%. Conclusions: The Idylla™ EGFR Mutation Test passed its clinical validity performance characteristics for accuracy.
Efficacy of the Otago-Exercise-Programme to reduce falls in community-dwelling adults aged 65-80 when delivered as group or individual training: Non-inferiority-clinical-trial
(BioMed Central (BMC), 2024-10-01) Albornos-Muñoz, Laura; Blanco-Blanco, Joan; Cidoncha-Moreno, María Ángeles; Abad-Corpa, Eva; Rivera-Álvarez, Araceli; López-Pisa, Rosa María; Caperos, José-Manuel; Otago Project Working Group Consortium; Moreno-Casbas, Teresa; Rich-Ruiz, Manuel; Rodriguez Baz; Agencia Estatal de Investigación (España); Instituto de Salud Carlos III; Fundación para la Formación e Investigación Sanitarias de la Región de Murcia; Basque Foundation for Health Innovation and Research
Background: The Otago Exercise Programme is an effective intervention for falls prevention. However, there is limited evidence in relation to studies that compare efficacy for falls prevention when delivered Otago Exercise Programme in a group or individual format in a primary care context. Objective: To compare the Otago Exercise Programme delivered as a group vs. individual format for community dwelling older adults, over a one year period. The hypothesis was that neither format would be inferior to the other. Methods: DESIGN: A four-year multicentre, randomized, non-inferiority clinical trial, with two arms- Otago Exercise Programme group training and individual Otago exercise training. Setting(s): 21 primary healthcare centers. Participants: A sample size of 728 participants was established. Participants were aged between 65 and 80 years; living in the community; able to walk independently; and agreed to take part in the study and provided signed informed consent. Intervention: The Otago Exercise Programme was delivered mainly by nurses in primary care, with five face to face sessions, and a reinforcement 6 months later. Participants were encouraged to exercise at home between face to face sessions. Data collection: at baseline and after 6 and 12 months from October 2017 to 2020. Primary outcome: people who reported at least one fall. Secondary outcomes: number of falls, cause of falls, consequences and assistance, adherence and satisfaction. Group allocation was blinded to the researchers involved in analysis. Reporting: Consolidated Standards of Reporting Trials recommendations for the Statement for Randomized Trials of Nonpharmacologic Treatments. Results: Eight hundred twenty-seven participants were randomized (226 were allocated in group training and 272 in individual training). The analysis of the proportion of people who reported at least one fall and number of falls showed no differences between individual and group training. Assessment of the equivalence between the interventions at 12 months showed that the confidence interval for the difference of people who reported at least one fall was found to be within the equivalence limit of 10% considered. However, in those participants with a previous history of falls, group format showed potentially greater benefit. The participants in individual training presented higher scores on the Exercise Adherence Rating Scale test. No differences were found in satisfaction between the groups. Conclusions: The group Otago Exercise Programme is equivalent to individually delivered Otago Exercise Programme in terms of prevention of falls over a 12-month follow up. Adherence was higher in individual training. Implications: Healthcare professionals could offer either Otago Exercise Programme format dependent on patient preference and be confident that that standardized intervention provides patient benefit. Trial registration: ClinicalTrials.gov (NCT03320668). Data registration 31/10/2017.
Risk Factors Associated with Mortality in Severe Chest Trauma Patients Admitted to the ICU
(Multidisciplinary Digital Publishing Institute (MDPI), 2022-01) Barea-Mendoza, Jesus Abelardo; Chico-Fernandez, Mario; Quintana-Diaz, Manuel; Pérez-Bárcena, Jon; Servia-Goixart, Luis; Molina-Diaz, Ismael; Bringas-Bollada, Maria; Ruiz-Aguilar, Antonio Luis; Ballesteros-Sanz, Maria Angeles; Llompart-Pou, Juan Antonio; SEMICYU
Our objective was to determine outcomes of severe chest trauma admitted to the ICU and the risk factors associated with mortality. An observational, prospective, and multicenter registry of trauma patients admitted to the participating ICUs (March 2015-December 2019) was utilized to collect the patient data that were analyzed. Severe chest trauma was defined as an Abbreviated Injury Scale (AIS) value of ≥3 in the thoracic area. Logistic regression analysis was used to evaluate the contribution of severe chest trauma to crude and adjusted ORs for mortality and to analyze the risk factors associated with mortality. Overall, 3821 patients (39%) presented severe chest trauma. The sample's characteristics were as follows: a mean age of 49.88 (19.21) years, male (77.6%), blunt trauma (93.9%), a mean ISS of 19.9 (11.6). Crude and adjusted (for age and ISS) ORs for mortality in severe chest trauma were 0.78 (0.68-0.89) and 0.43 (0.37-0.50) (p < 0.001), respectively. In-hospital mortality in the severe chest trauma patients without significant traumatic brain injury (TBI) was 5.63% and was 25.71% with associated significant TBI (p < 0.001). Age, the severity of injury (NISS and AIS-head), hemodynamic instability, prehospital intubation, acute kidney injury, and multiorgan failure were risk factors associated with mortality. The contribution of severe chest injury to the mortality of trauma patients admitted to the ICU was very low. Risk factors associated with mortality were identified.
International Consensus Document on Obstructive Sleep Apnea
(Elsevier, 2022-01) Mediano San Andres, Olga; Gonzalez Mangado, Nicolas; Montserrat, Josep M; Luz Alonso-Alvarez, M; Almendros, Isaac; Alonso-Fernandez, Alberto; Barbe, Ferran; Borsini, Eduardo; Caballero-Eraso, Candelaria; Cano-Pumarega, Irene; de Carlos Villafranca, Felix; Carmona-Bernal, Carmen; Carrillo Alduenda, Jose Luis; Chiner, Eusebi; Cordero Guevara, Jose Aurelio; de Manuel, Luis; Duran Cantolla, Joaquin; Farre, Ramon; Franceschini, Carlos; Gaig, Carles; Garcia Ramos, Pedro; Garcia-Rio, Francisco; Garmendia, Onintza; Gomez Garcia, Teresa; Gonzalez Pondal, Silvia; Hoyo Rodrigo, M. Blanca; Lecube, Albert; Antonio Madrid, Juan; Maniegas Lozano, Lourdes; Martinez Carrasco, Jose Luis; Fernando Masa, Juan; Masdeu Margalef, Maria Jose; Mayos Perez, Merce; Mirabet Lis, Enrique; Monasterio, Carmen; Navarro Soriano, Nieves; Olea de la Fuente, Erika; Plaza, Guillermo; Puertas Cuesta, Francisco Javier; Rabec, Claudio; Resano, Pilar; Rigau, David; Roncero, Alejandra; Ruiz, Concepcion; Salord, Neus; Saltijeral, Adriana; Sampol Rubio, Gabriel; Sanchez Quiroga, M. Angeles; Sans Capdevila, Oscar; Teixeira, Carlos; Tinahones, Francisco J; Maria Togeiro, Sonia; Troncoso Acevedo, Maria Fernanda; Vargas Ramirez, Leslie Katherine; Winck, Joao; Zabala Urionaguena, Nerea; Egea Santaolalla, Carlos; Spanish Sleep Network
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a document a list from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).
Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial
(Oxford University Press, 2021-05-01) Pujol, Miquel; Miró, José María; Shaw, Evelyn; Aguado, José María; San-Juan, Rafael; Puig-Asensio, Mireia; Pigrau, Carles; Calbo, Esther; Montejo, Miguel; Rodriguez-Alvarez, Regino; Garcia-Pais, Maria-Jose; Pintado, Vicente; Escudero-Sanchez, Rosa; Lopez-Contreras, Joaquin; Morata, Laura; Montero, Milagros; Andres, Marta; Pasquau, Juan; Arenas, Maria-del-Mar; Padilla, Belen; Murillas, Javier; Jover-Saenz, Alfredo; Lopez-Cortes, Luis Eduardo; Garcia-Pardo, Graciano; Gasch, Oriol; Videla, Sebastian; Hereu, Pilar; Tebe, Cristian; Pallares, Natalia; Sanllorente, Mireia; Dominguez, Maria-Angeles; Camara, Jordi; Ferrer, Ana; Padulles, Ariadna; Cuervo, Guillermo; Carratalà, Jordi; MRSA Bacteremia (BACSARM) Trial Investigators
Background. We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis. Methods. A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy. Results. of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93-1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018). Conclusions. Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events.
Genome-Wide Association Study of VKORC1 and CYP2C9 on acenocoumarol dose, stroke recurrence and intracranial haemorrhage in Spain
(Nature Publishing Group, 2020-02-18) Cullell, Natalia; Carrera, Caty; Muino, Elena; Torres-Aguila, Nuria-Paz; Carcel-Marquez, Jara; Gonzalez-Sanchez, Jonathan; Gallego-Fabrega, Cristina; Molina, Jessica; Besora, Sarah; Sotoca, Javier; Buongiorno, Maria-Teresa; Jimenez-Conde, Jordi; Giralt-Steinhauer, Eva; de Torres-Chacon, Reyes; Montaner, Joan; Mancha, Fernando; Cabezas, Juan A; Marti-Fabregas, Joan; Prats-Sanchez, Luis; Camps-Renom, Pol; Purroy, Francisco; Cambray, Serafi; Freijo Guerrero, Maria del Mar; Vives-Bauza, Cristofol; Tur Campos, Silvia; Font, Maria-Angels; Lopez-Cancio, Elena; Hernandez-Perez, Maria; Obach, Victor; Calleja, Ana; Arenillas, Juan Francisco; Rodriguez-Yanez, Manuel; Castillo, Jose; Sobrino, Tomas; Fernandez-Cadenas, Israel; Krupinski, Jerzy
Acenocoumarol is an oral anticoagulant with significant interindividual dose variations. Variants in CYP2C9 and VKORC1 have been associated with acenocoumarol maintenance dose. We analysed whether any of the 49 polymorphisms in CYP2C9 and VKORC1 previously associated with acenocoumarol maintenance dose in a Genome-Wide Association study (GWAs) in Dutch population are associated with stroke recurrence, intracranial haemorrhage (ICH) and acenocoumarol maintenance dose in a Spanish population. We performed a GWAs using Human Core Exome-chip (Illumina) in 78 patients stroke patients treated with acenocoumarol for secondary prevention enrolled as part of the prospective investigator-initiated study (IIS) SEDMAN Study. Patients were followed-up a median of 12.8 months. Three and eight patients had recurrent stroke and ICH events, respectively. We found 14 of the 49 published variants associated with acenocoumarol maintenance dose (p<0.05). Six polymorphisms were associated with stroke recurrence and four variants with ICH (p<0.05). In conclusion, variants in VKORC1 and CYP2C9 are associated with acenocoumarol maintenance dose, stroke recurrence and ICH in a Spanish cohort. These results highlight the relevance of studying pharmacogenetics associated with efficacy and safety of anticoagulant drugs and justify studies with larger sample size and different ethnic populations.
The Health Consequences of Neocolonialism for Latin American Immigrant Women Working as Caregivers in Spain: A Multisite Qualitative Analysis
(Multidisciplinary Digital Publishing Institute (MDPI), 2020-11) Briones-Vozmediano, Erica; Rivas-Quarneti, Natalia; Gea-Sanchez, Montserrat; Bover-Bover, Andreu; Antonia Carbonero, Maria; Gastaldo, Denise
In Spain, most jobs available for Latin American immigrant women are in intimate labour (caregiving and domestic work). This work is usually performed under informal employment conditions. The objective of this study was to explain how the colonial logic mediates the experiences of Latin American women working in intimate labour in Spain, and the effects of such occupation on their health and wellbeing, using a decolonial theoretical framework. A multi-site secondary data analysis of qualitative data from four previous studies was performed utilizing 101 interviews with Latin American immigrant women working as caregivers in Spain. Three interwoven categories show how the dominant colonial logic in Spain creates low social status and precarious jobs, and naturalizes intimate labour as their metier while producing detrimental physical and psychosocial health consequences for these immigrant caregivers. The caregivers displayed several strategies to resist and navigate intimate labour and manage its negative impact on health. Respect and integration into the family for whom they work had a buffering effect, mediating the effects of working conditions on health and wellbeing. Based on our analysis, we suggest that employment, social, and health protection laws and strategies are needed to promote a positive working environment, and to reduce the impact of caregiving work for Latin American caregivers.
New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The Time-Within-Remission Range
(Multidisciplinary Digital Publishing Institute (MDPI), 2020-04) de Hollanda, Ana; Lecube, Albert; Rubio, Miguel Angel; Sanchez, Enric; Vilarrasa, Nuria; Oliva, Jose Gregorio; Fernandez-Soto, Maria Luisa; Salas-Salvado, Jordi; Ballesteros-Pomar, Maria D.; Ciudin, Andreea; Torres, Ferran; Vidal, Concepcion; Morales, Maria Jose; Valdes, Sergio; Pellitero, Silvia; Minambres, Inka; Masmiquel, Lluis; Goday, Albert; Suarez, Lorena; Flores, Liliam; Bueno, Marta; Caixas, Assumpta; Breton, Irene; Camara, Rosa; Olbeyra, Romina; Penso, Rona; de la Cruz, Maria Jose; Simo-Servat, Andreu; Pereyra-Garcia, Francisca Maria; Lopez-Mezquita, Elena Teresa; Gils, Anna; Fidilio, Enzamaria; Bandres, Orosia; Martinez, Angel; Abuin, Jose; Marques-Pamies, Montserrat; Tuneu, Laura; Arteaga, Magdalena; Castaner, Olga; Goñi, Fernando; Arrizabalaga, Cristina; Antonio Botana, Manuel; Calanas, Alfonso; Rebollo, Angel
Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the time-within-remission range as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 +/- 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, time-within-remission range and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 +/- 9.2 years old, body mass index (BMI) 46.3 +/- 6.9 kg/m(2)) underwent primary bariatric procedures. Time-within-remission range were 83.3% (33.3-91.6) after gastric bypass, 68.7% (7.1-87.5) after sleeve gastrectomy and 90% (83.3-92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the time-within-remission range. The association of bariatric techniques with time-within-remission range, using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34-5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40-0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The time-within-remission range unveils a superiority of gastric bypass compared to sleeve gastrectomy.
Machine learning techniques for mortality prediction in critical traumatic patients: anatomic and physiologic variables from the RETRAUCI study
(BioMed Central (BMC), 2020-10-20) Servia, Luis; Montserrat, Neus; Badia, Mariona; Llompart-Pou, Juan Antonio; Abelardo Barea-Mendoza, Jesus; Chico-Fernandez, Mario; Sanchez-Casado, Marcelino; Jimenez, Jose Manuel; Maria Mayor, Dolores; Trujillano, Javier
Background: Interest in models for calculating the risk of death in traumatic patients admitted to ICUs remains high. These models use variables derived from the deviation of physiological parameters and/or the severity of anatomical lesions with respect to the affected body areas. Our objective is to create different predictive models of the mortality of critically traumatic patients using machine learning techniques. Methods: We used 9625 records from the RETRAUCI database (National Trauma Registry of 52 Spanish ICUs in the period of 2015-2019). Hospital mortality was 12.6%. Data on demographic variables, affected anatomical areas and physiological repercussions were used. The Weka Platform was used, along with a ten-fold cross-validation for the construction of nine supervised algorithms: logistic regression binary (LR), neural network (NN), sequential minimal optimization (SMO), classification rules (JRip), classification trees (CT), Bayesian networks (BN), adaptive boosting (ADABOOST), bootstrap aggregating (BAGGING) and random forest (RFOREST). The performance of the models was evaluated by accuracy, specificity, precision, recall, F-measure, and AUC. Results: In all algorithms, the most important factors are those associated with traumatic brain injury (TBI) and organic failures. The LR finds thorax and limb injuries as independent protective factors of mortality. The CT generates 24 decision rules and uses those related to TBI as the first variables (range 2.0-81.6%). The JRip detects the eight rules with the highest risk of mortality (65.0-94.1%). The NN model uses a hidden layer of ten nodes, which requires 200 weights for its interpretation. The BN find the relationships between the different factors that identify different patient profiles. Models with the ensemble methodology (ADABOOST, BAGGING and RandomForest) do not have greater performance. All models obtain high values in accuracy, specificity, and AUC, but obtain lower values in recall. The greatest precision is achieved by the SMO model, and the BN obtains the best recall, F-measure, and AUC. Conclusion: Machine learning techniques are useful for creating mortality classification models in critically traumatic patients. With clinical interpretation, the algorithms establish different patient profiles according to the relationship between the variables used, determine groups of patients with different evolutions, and alert clinicians to the presence of rules that indicate the greatest severity.
Gut epithelial barrier markers in patients with obstructive sleep apnea
(Elsevier, 2016-10) Barceló Bennasar, Antonia; Esquinas, Cristina; Robles, Juan; Pierola Lopetegui, Javier; de la Pena-Bravo, Monica; Aguilar, Irene; Morell Garcia, Danie; Alonso, Alberto; Toledo Pons, Nuria; Sanchez-de la Torre, Manuel; Barbe, Ferran
Background: Obstructive sleep apnea (OSA) is now being recognized as an additional contributing factor to the pathogenesis of obesity-related comorbidities. At the same time, there is now increasing evidence to suggest that intestinal wall permeability plays a role in the development of metabolic syndrome. In the present study, circulating zonulin and fatty acid binding protein (I-FABP) were measured in association with metabolic, hepatic, and inflammatory parameters. Results: Compared with controls, plasma I-FABP levels were significantly higher in patients with OSA (571 pg/mL [IQR 290-950] vs 396 pg/mL [IQR 234-559], p = 0.04). Zonulin levels were similar between groups. Significant relationships were observed between zonulin levels and waist circumference (p < 0.05), glucose (p < 0.05), and insulin (p < 0.05). In addition, in the OSA group, zonulin levels correlated negatively with the mean nocturnal oxygenation saturation (p < 0.05) and positively with total cholesterol (p < 0.05), alanine aminotransferase (ALT) (p < 0.005), aminotransferase (AST) (p < 0.01), gamma glutamyltransferase (GGT) (p < 0.005), and high-sensitivity C-reactive protein (hs-CRP) (p < 0.05). Multivariate analysis showed that associations between zonulin and ALT, AST, and hs-CRP were attenuated, but not eliminated, after adjustment for other variables. Conclusions: The results of this study suggest that OSA is a risk factor for intestinal damage, regardless of metabolic profile, and that intestinal permeability might be a possible contributor to nonalcoholic fatty liver disease in patients with OSA.
Effect of Patient Sex on the Severity of Coronary Artery Disease in Patients with Newly Diagnosis of Obstructive Sleep Apnoea Admitted by an Acute Coronary Syndrome
(Public Library of Science (PLOS), 2016-07-14) Sanchez-de-la-Torre, Alicia; Abad, Jorge; Duran Cantolla, Joaquin; Mediano San Andres, Olga; Cabriada, Valentin; Jose Masdeu, Maria; Teran, Joaquin; Fernando Masa, Juan; de la Pena-Bravo, Monica; Aldoma, Albina; Worner, Fernando; Valls, Joan; Barbe, Ferran; Sanchez-de-la-Torre, Manuel; Spanish Sleep Grp
Background: The cardiovascular consequences of obstructive sleep apnoea (OSA) differ by sex. We hypothesized that sex influences the severity of acute coronary syndrome (ACS) in patients with OSA. OSA was defined as an apnoea-hypopnoea index (AHI)>15 events.h(-1). We evaluated the severity of ACS according to the ejection fraction, Killip class, number of diseased vessels, number of stents implanted and plasma peak troponin level. Methods We included 663 men (mean +/- SD, AHI 37 +/- 18 events.h(-1)) and 133 women (AHI 35 +/- 18 events.h(-1)) with OSA. Results: The men were younger than the women (59 +/- 11 versus 66 +/- 11 years, p<0.0001), exhibited a higher neck circumference (p<0.0001), and were more likely to be smokers and alcohol users than women (p<0.0001, p = 0.0005, respectively). Body mass index and percentage of hypertensive patients or diabetics were similar between sexes. We observed a slight tendency for a higher Killip classification in women, although it was not statistically significant (p = 0.055). For men, we observed that the number of diseased vessels and the number of stents implanted were higher (p = 0.02, p = 0.001, respectively), and a decrease in the ejection fraction (p = 0.002). Conclusions: This study shows that sex in OSA influences the severity of ACS. Men show a lower ejection fraction and an increased number of diseased vessels and number of stents implanted.
Impact of Obstructive Sleep Apnea on the Levels of Placental Growth Factor (PlGF) and Their Value for Predicting Short-Term Adverse Outcomes in Patients with Acute Coronary Syndrome
(Public Library of Science (PLOS), 2016-03-01) Barceló Bennasar, Antonia; Bauça, Josep Miquel; Yáñez, Aina M; Fueyo, Laura; Gómez Cobo, Cristina; de la Pena-Bravo, Monica; Pierola Lopetegui, Javier; Rodriguez, Alberto; Sanchez-de-la-Torre, Manuel; Abad, Jorge; Mediano San Andres, Olga; Amilibia, Jose; Jose Masdeu, Maria; Teran, Joaquin; Maria Montserrat, Josep; Mayos, Merce; Sanchez-de-la-Torre, Alicia; Barbe, Ferran; Spanish Sleep Grp
Background Placental growth factor (PlGF) induces angiogenesis and promotes tissue repair, and plasma PlGF levels change markedly during acute myocardial infarction (AMI). Currently, the impact of obstructive sleep apnea (OSA) in patients with AMI is a subject of debate. Our objective was to evaluate the relationships between PlGF levels and both the severity of acute coronary syndrome (ACS) and short-term outcomes after ACS in patients with and without OSA. Methods A total of 538 consecutive patients (312 OSA patients and 226 controls) admitted for ACS were included in this study. All patients underwent polygraphy in the first 72 hours after hospital admission. The severity of disease and short-term prognoses were evaluated during the hospitalization period. Plasma PlGF levels were measured using an electrochemiluminescence immunoassay. Results Patients with OSA were significantly older and more frequently hypertensive and had higher BMIs than those without OSA. After adjusting for age, smoking status, BMI and hypertension, PlGF levels were significantly elevated in patients with OSA compared with patients without OSA (19.9 pg/mL, interquartile range: 16.6-24.5 pg/mL; 18.5 pg/mL, interquartile range: 14.7-22.7 pg/mL; p<0.001), and a higher apnea-hypopnea index (AHI) was associated with higher PlGF concentrations (p<0.003). Patients with higher levels of PlGF had also an increased odds ratio for the presence of 3 or more diseased vessels and for a Killip score>1, even after adjustment. Conclusions The results of this study show that in patients with ACS, elevated plasma levels of PlGF are associated with the presence of OSA and with adverse outcomes during short-term follow-up.
Changes in Group A Streptococcus emm Types Associated with Invasive Infections in Adults, Spain, 2023
(Centers for Disease Control and Prevention (CDC), 2023-11) Bellés-Bellés, Alba; Prim, Núria; Mormeneo-Bayo, Saray; Villalón, Pilar; Valiente, Mónica; Jover-Sáenz, Alfredo; Aixalà, Núria; Bernet, Albert; López-González, Éric; Prats, Ivan; García-González, Mercè
An increase in invasive group A Streptococcus infection was detected in the northeast of Spain in November 2022. A postpandemic decline in the diversity of circulating emm types involved in invasive group A Streptococcus was observed, along with the emergence of emm49 in this geographic area.
CKD: The burden of disease invisible to research funders.
(2021-11-17) AIRG-E, EKPF, ALCER, FRIAT, REDINREN, RICORS2040, SENEFRO; SET, ONT
The uptake of the current concept of chronic kidney disease (CKD) by the public, physicians and health authorities is low. Physicians still mix up CKD with chronic kidney insufficiency or failure. In a recent manuscript, only 23% of participants in a cohort of persons with CKD had been diagnosed by their physicians as having CKD while 29% has a diagnosis of cancer and 82% had a diagnosis of hypertension. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. A prevalent view is that for those in whom kidneys fail, the problem is "solved" by dialysis or kidney transplantation. However, the main burden of CKD is accelerated aging and all-cause and cardiovascular premature death. CKD is the most prevalent risk factor for lethal COVID-19 and the factor that most increases the risk of death in COVID-19, after old age. Moreover, men and women undergoing KRT still have an annual mortality which is 10-100-fold higher than similar age peers, and life expectancy is shortened by around 40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth global cause of death by 2040 and the second cause of death in Spain before the end of the century, a time when 1 in 4 Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded CIBER network research structure in Spain. Leading Spanish kidney researchers grouped in the kidney collaborative research network REDINREN have now applied for the RICORS call of collaborative research in Spain with the support of the Spanish Society of Nephrology, ALCER and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true. However, only the highest level of research funding through the CIBER will allow to adequately address the issue before it is too late.

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